What to Expect from Total Hip Replacement Surgery

LifeScript.com—May 10, 2011

Your doctor says you need total hip replacement surgery – and your painful hip says it too. Worried as you may be, there’s little down side to this common operation: Hip replacements are faster and safer than ever with new materials and surgical procedures. Find out about the recent innovations and what to expect as you recover…

When a hip joint is damaged by arthritis, the pain can be unbearable. That’s the time to talk to an orthopedic surgeon about hip replacement, says Geoffrey Westrich, M.D., director of joint-replacement research at Hospital for Special Surgery in New York City.

“Once people have hip pain that affects their daily lives – climbing stairs, getting up from a chair, difficulty walking – it’s time for a consultation,” he says.

“Hip replacement surgery is one of the safest surgeries we perform,” Westrich says.

And now it’s getting even safer. Incisions are smaller, recovery time faster, and there are more surgical options to choose from.

The newer operations, called minimally invasive surgeries, no longer require incisions of 6-9 inches, which were necessary in the past, Westrich says.

“Now we make relatively small incisions of about 3 inches,” Westrich says. “And we’ve designed [smaller] instruments to use during surgeries.”

Special Concerns for WomenAbout the same number of women and men have hip replacements, according to a 2009 report by the Centers for Disease Control and Prevention.

But women are more likely to be in severe discomfort by the time they get joint pain treatment, according to a 2011 study Westrich presented to the American Academy of Orthopaedic Surgery.This may be partly because they’re more likely to live alone than men, making them apprehensive about who will care for them after surgery, Westrich says. But it’s wise not to wait.

If someone waits and has more pain and disability before surgery, there’s a greater risk for problems later, he adds.

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Rehab and RecoveryMost hip replacement patients are hospitalized for about three days, says Lisa Konstantellis, section manager of the Joint Mobility Center at Hospital for Special Surgery. A day after surgery, a physical therapist reviews precautions for the next six weeks.

“You’re not allowed to bend your hip more than 90°,” Konstantellis says. “That means if you’re sitting in a chair, your knee should be lower than your hip. ”

The therapist will also ask you to avoid crossing your legs until the replacement sets solidly in place. Crossing legs “could dislocate the new hip,” Konstantellis warns.

From day 1, you’ll be doing a lot of exercises. For example, the therapist will ask you to push the back of your knee into the bed mattress, tightening your thigh muscles.

“We ask patients to do 10 repetitions of each exercise every hour they’re awake,” Konstantellis says.

“A lot of these people have been limping for a long time because the hip is in pain from arthritis, so we have to teach them how to stand straight and not favor that leg anymore,” Konstantellis says.

“The therapist will focus on whatever’s difficult for the patient, working on stretching, strengthening and balance,” Konstantellis says. “The patient will also have a home exercise program to do 3-4 times a week.”

Managing Pain

Some patients can get by with over-the-counter acetaminophen (Tylenol).

If you haven’t moved your hips for years before surgery, you may never return to a full range of motion, warns Westrich.

“It’s not just the hip but the muscles around it that are affected,” he says. If they haven’t been used, they atrophy.

New Hip, New LifeHip replacement is hardly fun. But the results can be.

“Most people can’t believe the pain is gone,” Konstantellis says. “They can start doing things that they haven’t been able to do for years. Most people see progress every week after surgery.”

Most hip replacement patients can’t return to high-impact sports like running, but they can play golf and do yoga.

“And sex is fine,” Konstantellis says. “Just not within the first six weeks.”